Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | IL |
NPI | 1508065558 |
---|---|
Provider Name | Dr. James J Klemens |
First Address | Peoria, IL 61614-2017 |
Second Address | Peoria, IL 61614-2017 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2007 |
Last Update Date | 11/07/2007 |